Asian Americans/Pacific Islanders and mental health
Asian Americans and Pacific Islanders represent a diverse and rapidly growing demographic in the United States, with unique mental health challenges influenced by cultural, social, and immigration factors. As of the early 21st century, most Asian American subgroups, apart from Japanese, Hmong, and Filipino populations, are primarily foreign-born. The process of acculturation—adapting to a new culture—can increase the risk of mental health issues, including depression and anxiety. Despite their overall educational achievements and economic success, there is significant underutilization of mental health services among this population, often due to cultural stigma, language barriers, and a preference for familial problem-solving. Research indicates that while mental illness rates may be lower among Asian Americans than whites, this group is less likely to seek help, with variations noted based on factors such as birthplace and social status. Mental health problems often stem from the immigrant experience and cultural stressors, including intergenerational conflict and racism. The holistic approach to mental health care, which integrates physical and mental health services, has shown promise in addressing these issues, particularly for those who may attribute their problems to physical rather than mental causes. Understanding the intricate cultural values and beliefs within this diverse community is crucial for providing effective mental health support.
Asian Americans/Pacific Islanders and mental health
- TYPE OF PSYCHOLOGY: Multicultural psychology; Psychotherapy; stress
The number of Asian Americans and Pacific Islanders in the American population is growing rapidly. Although research on the utilization of mental health services by this group has been inconsistent, evidence suggests that individuals from Asian cultures tend to underutilize formal mental health services. It is not clear, however, whether this is primarily due to discriminatory mental health practices and culturally unaware mental health practitioners or to cultural values that inhibit self-referral.
Introduction
Asian Americans/Pacific Islanders constitute the fastest-growing ethnic category in the United States according to the US Census Bureau (2010). The population of US residents of Asian descent nearly doubled between the 2000 and 2019 censuses, while the population of Native Hawaiians and other Pacific Islanders saw slower growth. As of the third decade of the twenty-first century, the majority of every Asian American subgroup, except for Japanese, Hmong, and Filipino, was foreign born. The acculturation process—the acquisition of new values, norms, language, and behavior when an immigrant moves from one culture to another—can place the individual at risk for serious illness or depression. Studies of immigrants in the United States suggest that the acculturation process places the immigrant at risk for a lifetime of psychiatric disorders. Whether illness occurs is influenced by a number of factors, including the degree to which reality matches the immigrant’s expectations.
The Asian American Community
Asian Americans are a heterogeneous group, representing from thirty to fifty different cultural subgroups, depending on whether Pacific Islanders are included. Subgroups include East Asians such as the Chinese, Koreans, and the Japanese; Southeast Asians such as the Vietnamese, Laotians, Cambodians, Thais, Malaysians, Indonesians, the Burmese, Hmongs, and Filipinos; and South Asians such as people from India, Bangladesh, Bhutan, the Maldives, Nepal, Pakistan, and Sri Lanka. Pacific Islanders include the Indigenous peoples of Hawaii, Samoa, and Guam.
Much of the literature regarding the psychology of Asian Americans/Pacific Islanders is based on the Chinese and Japanese subgroups and therefore does not necessarily apply to the other subgroups, particularly the Pacific Islanders, whose cultural traditions are markedly different from those of Asian Americans.
The stereotypical image of Asian Americans and Pacific Islanders is of a well-educated and financially successful group of people, but there are significant overall differences between the two groups and between them and the US population as a whole. The US Census Bureau reported that the estimated median income of Asian American families in 2023 was $111,817 compared to that of American families as a whole at $77,719 and Native Hawaiian and Other Pacific Islander families at $74,257. Similarly, 59.3 percent of all Asian Americans age twenty-five or higher had attained a bachelor's degree or higher, versus 34.5 percent of US residents and 17.5 percent of Native Hawaiians and Other Pacific Islanders in the same age range. Also, while the Asian American group exhibits a high level of educational achievement, there is significant variation among subgroups. For example, about 16 percent of Cambodians, 18 percent of Laotians, and 18 percent of Hmongs twenty-five years and older had a bachelor’s degree in 2019.
Underutilization of Mental Health Services
The successful image of Asian Americans is at odds with the growing recognition that this population needs more mental health services than it receives. The underutilization of such services may be due to a number of factors, including discriminatory mental health practices, the shame and disgrace associated with having mental or emotional problems in many Asian cultures, language barriers, and lack of insurance. In addition, many Asians place a high value on handling problems within the family, as opposed to relying on outside resources, especially in a culture that is not their own. Asian Americans have demonstrated a pattern of prematurely terminating psychotherapy.
Research has been conducted to explore how differences in birthplace (overseas or in the United States), age, social status, and immigration status may affect the prevalence of mental health disorders, as well as the likelihood of seeking professional help. The National Latino and Asian American Study, concluded in 2003, found that mental illness rates are lower among Asian Americans than White Americans, but Asian Americans are less likely to seek treatment for their problems. However, the study also found that although Vietnamese Americans are diagnosed with mental illness at rates similar to those of other Asian American groups, they were found to be much more likely to seek help, possibly because many of them had experienced war-related trauma in their country of origin. Asian Americans who were born in the United States or immigrated at an early age were found to have higher rates of mental illness than Asian Americans as a whole, perhaps because they were more exposed to American culture and thus experienced more conflict in everyday life.
Mental health centers typically do not reach out to any ethnic population, including Asian Americans/Pacific Islanders, unless they employ professionals from that ethnicity. However, some mental health centers and professionals are taking a holistic approach to mental health for Asian Americans by combining primary and mental health care. This approach is effective for Asian immigrants, who often assume that their illness has a physical rather than mental cause. They therefore typically consult a physician instead of a mental health professional with conditions caused or worsened by mental or emotional problems. The holistic approach is also effective for integrating Western and Eastern philosophies and finding a way to make dealing with mental illness more acceptable for Asians.
The Nature of the Problems
Often the mental health problems of Asian Americans are directly related to the immigrant experience. Learning to deal with the values, norms, language, and behaviors of another culture often adds to the stress levels of immigrants and later generations of their families who identify with the ethnic subgroup and want to maintain its traditions. Common stressors for Asian Americans/Pacific Islanders include intergenerational conflict, the process of developing cultural identities, immigration status, and racism.
Stress, depression, and suicide have been identified as mental health problems within the Asian American community. Asian immigrants may become depressed when they are unable to obtain professional employment equivalent to the highly respected positions they held in their home country because of language difficulties or differences in accreditation.
In 2024, the US Department of Health and Human Services Office of Minority Health reported the following data: Suicide was the leading cause of death for Asian Americans/Pacific Islanders ages fifteen to twenty-four years in 2022. In 2023, Asian American adults were half as likely as non-Hispanic White adults to have received mental health treatment. Southeast Asian refugees were at risk for post-traumatic stress disorder (PTSD) linked to trauma they experienced before and after immigrating to the United States, with one 2006 study finding that 70 percent of Southeast Asian refugees who were receiving mental health care had been diagnosed with PTSD.
The Role of Cultural Values
People vary in the degree that they experience cultural stress and in the degree to which they reveal its direct relationship to the problem they are experiencing. Mental health personnel who are culturally competent will be sensitive to the increased possibility for this type of stress to be experienced by Asian Americans/Pacific Islanders.
Mental health professionals treating Asian Americans will find it useful to know their traditional cultural values and how they differ from Western values. At the same time, they must remember that great variation exists within and between groups. In addition, the degree to which Asian Americans adhere to traditional cultural values will vary, influenced by factors such as their place of birth (overseas or the United States) and their family upbringing (traditional or unconventional).
An examination of one subgroup of Asian Americans, East Asians, reveals both differences of the group as a whole from Western culture and variations within the subgroup. East Asian cultures, some of the oldest continuously existing cultures in the world, have significantly different values from Western cultures. For example, the prominent East Asian philosophical approaches to life are Confucianism, Daoism, and Buddhism rather than Judaism and Christianity. The family and the family network are valued above the individual. Although Western families value the autonomy of their members, families that adhere to the Confucian tradition are more likely to support the establishment of a hierarchy among their members. Under the Confucian tradition, an individual must adhere to a code of conduct that reflects the beliefs of the family and kinship network to which the individual belongs, rather than one that reflects the individual’s beliefs.
Just as important are the differences among East Asian cultures. Individuals from Western cultures often assume there is little difference among Chinese, Japanese, and Koreans. In reality, there are many differences, the most obvious of which is language.
A group of Asian American mental health practitioners identified cultural values or traits that they believed played a role in mental health settings. Listed in declining order of importance, they were feelings of shame and guilt, respect for others based on role and status, reserved interpersonal styles of behavior, the stigma of mental illness, the restraint of self-expression, a group orientation, the high value placed on achievement, a sense of duty and obligation, and role expectations.
Although mental health professionals must be mindful of Asian cultural influences, they also must be careful not to automatically assign Asian values and traits to Asian American individuals.
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